Thursday 26 April, 2007
The management of asthma is clearly and in excruciating detail described by the National Asthma Council of Australia. Last year, the NAC published the 2006 update to the Asthma Management Handbook (1) which for all intents and purposes, should be considered the “gospel” of asthma management. Nevertheless, I have a number of criticisms against the publication. According to its own introduction, it is designed as an evidence-based guideline of asthma management aimed at general practitioners. However, I question whether more than a handful of GPs would actually read the entire 157 pages of the handbook! The lack of summary pages on management is unhelpful.
This article was written to address some of the deficiencies by distilling the management of asthma in adults into digestible chunks.
Wednesday 7 February, 2007
All too often for JMOs, physical examination of the hands is forgotten. In situations other than test conditions, most people “go for the money” – jumping immediately to the body system expected to have the problem. This is perhaps understandable in the time poor hospital environment.
Nevertheless, I feel that all physical examination should always begin with the hands. Even if there are no specific physical signs, the hands can tell you much about the patient:
- Are they warm and well perfused?
- Is the patient nervous and sweaty?
- Do the hands tell you something about the patient’s occupation and lifestyle?
Tuesday 6 February, 2007
Writing an R/PBS (repatriation/pharmaceutical benefits scheme) presciption (aka “external” script for hospital based JMOs) is easy and simple when you know how. Incredibly (looking retrospectively), I don’t think that anyone actually went through with me how to write one. I’m sure there were more than a handful of community pharmacists shaking their heads (or their fists) at my dodgey scripts when I was a resident in ED!
This article is aimed mostly at interns and residents on how to write a community R/PBS prescription.
Saturday 6 January, 2007
There has been much in the media recently about the new cervical cancer vaccine, “Gardasil”. The first vaccine was initially produced in the 1990s by a team of researchers in Queensland, headed by Professor Ian Frazer; who received Australian of the Year in 2006 for his work. The vaccine was then marketed by CSL pharmaceuticals and released in 2006. It is a vaccine aimed at preventing infection with the human papilloma virus (HPV), also known as the wart virus.
There is a clear relationship to human papilloma virus (HPV) and the development of cervical cancer (1). There are more than 100 different forms of human papilloma virus (HPV), but not all of them are linked to causation of cervical cancer (2). HPV 16 and 18 are indicated in causing over 70% of cervical cancers detected. The other genotypes linked to developing cervical cancer are types 45 and 31. Types 6 and 11 are linked to the clinical manifestation of genital warts and are low risk for developing cervical cancer.
Sunday 3 December, 2006
Opioid analgesics are the cornerstone to treatment and control of severe pain. Equivalence of dose potency is not absolute and care must be taken in changing analgesics. In general, it is safer to use a lower regular dose with breakthrough analgesia rather than to convert immediately to the “equivalent” dose.
It is important nevertheless to know the approximately dosage conversions.
Sunday 19 November, 2006
As medical students and doctors we know that obesity is bad. It leads to all sorts of problems – hypertension, hypercholesterolaemia, diabetes, ischaemic heart disease (and other vasculopathies), arthritis, obstructive sleep apnoea, gastro-oesophageal reflux disease. Certainly there is a much higher mortality and morbidity associated with being overweight or obese.
We have been aware of the term “metabolic syndrome” (also known as syndrome X, insulin resistance syndrome) since the 1970s. This is characterised by a group of metabolic risk factors in one person leading to an increased risk for diabetes type II, and for vascular disease such as ischaemic heart disease or cerebrovascular disease (1) (2). The biological reasons for why it occurs is poorly understood, however we are aware that abdominal obesity and increased insulin resistance plays a key factor.
Monday 16 October, 2006
Sunday 15 October, 2006
An understanding of how to start and setup an intravenous infusion of glyceryl trinitrate (GTN) is a rather useful skill. Unfortunately, setting up a GTN infusion is sufficiently complicated that it can’t be worked out in an emergency situation. In a nutshell:
Start with glyceryl trinitrate 5 mcg/min
increase infusion rate by 5 mcg/min every 3-5 minutes if needed
when infusion rate is GTN 20 mcg/min or more
increase infusion rate by 10 mcg/min every 3-5 minutes if needed
GTN infusions are not trivial. Call for help. It should best be performed under the supervision of someone who has experience with them (e.g., a medical registrar or emergency medicine registrar).
Sunday 8 October, 2006
In the major urban hospitals, there will be little place for thrombolysis in acute STEMI (ST-elevation myocardial infarction). Primary PCI (percutaneous coronary intervention) is clearly the treatment of choice (1).
Don’t forget to take documented informed consent prior to giving thrombolysis. It is a commonly forgotten step.
However, if you work in a rural or remote setting where the local hospital does not have a cardiologist who can offer primary PCI, then thrombolysis makes a difference. The 30-day mortality in newly diagnosed acute coronary syndrome from 1987-2000 decreased by 47%. This has been attributed to aspirin and coronary revascularisation procedures (e.g., thrombolysis and PCI) (2).
Wednesday 13 September, 2006
Menopause usually occurs in women aged between the ages of 45-55 years. In general women in their peri-menopausal years are more likely to seek medical advice than the post-menopausal woman.